title: Cost-effectiveness of computer-tailored smoking cessation advice in primary care: a randomized trial (ESCAPE).
abstract: BACKGROUND
  Smoking remains a significant public health problem and is a leading cause of preventable morbidity and mortality around the world. By combining the behavioral intervention principles used in specialist services with the high reach rates of public health interventions, personal tailored self-help cessation intervention provides a potential economical method for improving reach and effectiveness.
  
  
  METHODS
  Cost-effectiveness analysis is performed alongside a randomized controlled trial to compare the computer-tailored self-help intervention with a generic self-help intervention in smoking cessation. A Markov model was developed to extrapolate lifetime cost-effectiveness by combining trial data with estimates from the literature.
  
  
  RESULTS
  In the short term, smokers in the intervention group gained 0.0006 (95% CI = -0.0024 to 0.0036) quality-adjusted life years (QALYs) more than those in the control group at an increased cost of about £9 per person (95% CI = £5-£12). This yielded an incremental cost-effectiveness ratio (ICER) of £14,432/QALY. Precision of the ICER estimates was assessed by 5,000 bootstrapping replications. The probability that the intervention was cost effective was 54% (58%) at a cost-effectiveness threshold of £20,000(£30,000) per QALY. The Markov model showed that simulating lifetime outcomes improved the cost-effectiveness ratio (£9,700/QALY) in favor of the tailored intervention. The intervention would have a 55%-57% chance of being more cost effective than nontailored intervention at the willingness-to-pay threshold of £20,000-30,000/QALY.
  
  
  CONCLUSIONS
  The computer-tailored intervention appears slightly more likely to be cost effective than the generic self-help intervention in smoking cessation, in both the short term and the long term, but caution is required given the considerable uncertainty surrounding the estimates.
authors.affiliation: Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK;
authors.forename: Qi
authors.initials: Q
authors.lastname: Wu
authors.forename: Steve
authors.initials: S
authors.lastname: Parrott
authors.forename: Christine
authors.initials: C
authors.lastname: Godfrey
authors.forename: Hazel
authors.initials: H
authors.lastname: Gilbert
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
authors.forename: Baptiste
authors.initials: B
authors.lastname: Leurent
authors.forename: Stephen
authors.initials: S
authors.lastname: Sutton
authors.forename: Richard
authors.initials: R
authors.lastname: Morris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003201:Computers; D003362:Cost-Benefit Analysis; D006801:Humans; D008875:Middle Aged; D011320:Primary Health Care; D019057:Quality-Adjusted Life Years; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods*; D055815:Young Adult